Nursing care for high risk newborn, birth injury, high risk infants, intrcranial hemorrhage, brachial palsy, cerebral palsy, head injuries during birth or during delivery

1. Nursing Care Aspects for
High Risk newborn

2. 1. Birth injuries

3. I. Intracranial Hemorrhage
‘’Any bleeding within the intracranial vault,
including the brain parenchyma and
surrounding meningeal spaces.’’

4. Causes:
1. Sudden compression and decompression of the head
as in breech and hurried labour.
2. Marked compression by forceps or in cephalopelvic
disproportion.
3. Fracture skull.
Predisposing factors:
1. Prematurity due to physiological
hypoprothrombinemia, fragile blood vessels and
liability to trauma.
2. Blood diseases

5. Intracranial Haemorrhage Sites:
1. Subdural
2. Subarachnoid
3. Intraventricular
4. Intracerebral
The incidence of IVH increases
with decreasing birth weight
1. 60-70% of 500- to 750-g infants and
2. 10-20% of 1,000- to 1,500-g infants

6. Intracranial Haemorrhage
Clinical picture:
1- Altered consciousness
2- Flaccidity
3- Breathing is absent, irregular and periodic or gasping.
4- Eyes: no movement, pupils may be fixed and dilated
5- Opisthotonus, rigidity, twitches and convulsions.
6- Vomiting
7- High pitched cry
8- Anterior fontanelle is tense and bulging
9- Lumbar puncture reveals bloody C.S.F.

8. Investigations:
1. CT scan is the most reliable.
2. MRI
Prophylaxis:
1. Vitamin K: 10 mg IM to the mother in late pregnancy or early
in labour.
2. Episiotomy: especially in premature and breech delivery.
3. Forceps delivery
4. For baby supportive treatment :

9. II. Brachial Plexus Palsy:
It is due to over traction on the neck as in:
1. Shoulder dystocia
2. After-coming head in breech delivery

10. Brachial Plexus Palsy:
1) Erb's palsy:
 It is the common, due to injury to C5 and C6 roots.
 The upper limb drops beside the trunk, internally rotated
with flexed wrist.
2) Klumpke’s palsy:
 Due to injury to C7 and C8 and 1st thoracic roots.
 It leads to paralysis of the muscles of the hand and weakness of
the wrist and fingers.
(policeman’s or waiter’s tip hand).

11. Erb's palsy

12. Treatment:
 Support to prevent stretching of the paralyzed muscles
 Physiotherapy: massage, exercise and faradic stimulation
 Corticosteroid creams or injections
 Neuromuscular Electrical Stimulation (NMES)

15. Prognosis:
 Depends on whether the nerve was merely
injured or was lacerated.
 If the paralysis was due to edema and
hemorrhage about the nerve fibers, function
should return within a few months.
 If due to laceration, permanent damage may
result.
Treatment
 If the paralysis persists without improvement
for 3-6 months: neuroplasty, neurolysis, or
nerve grafting

16. To be continued…